Pediatric Rheumatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department Anesthesiology and Pain, Princess Máxima Centre for Pediatric Oncology, PO box 113, 3720, AC, Bilthoven, The Netherlands.
Pediatr Rheumatol Online J. 2022 Aug 9;20(1):63. doi: 10.1186/s12969-022-00715-5.
Juvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major early complaint, and in 10-17% pain remains a major symptom. Very few data exist on sensory threshold changes at the knee in JIA, a location in which inflammation often manifests. We determined whether JIA is associated with sensory threshold changes at the knee by using Quantitative Sensory Testing (QST) and established reference values at the knee of children.
Sixteen patients with JIA aged 9-18 years with one affected knee and a patient-reported pain by Visual Analog Scale (VAS) > 10 on a 0-100 scale, and 16 healthy controls completed the study and were included for the analysis. QST was assessed in compliance with the German Research Network on Neuropathic Pain (DFNS) standard. Disease severity was determined using Juvenile Disease Activity Score (JADAS. Perceived pain was assessed with a visual analogue scale(0-100). Feasibility of QST was tested in patients aged 6-9.
Under the age of 9, QST testing showed not to be feasible in 3 out of 5 JIA patients. Patients with JIA aged 9 and older reported an average VAS pain score of 54.3. QST identified a significant reduction in pressure pain threshold (PPT) and increase in cold detection threshold (CDT) compared to healthy controls. PPT is reduced in both the affected and the unaffected knee, CDT is reduced in the unaffected knee, not the affected knee.
In a Dutch cohort of Patients with JIA, QST is only feasible from 9 years and up. Also, sensory threshold changes at the knee are restricted to pressure pain and cold detection thresholds in Patients with JIA.
This article shows that in a Dutch population, the extensive QST protocol is only feasible in the age group from 9 years and older, and a reduced set of QST tests containing at least pressure pain thresholds and cold detection thresholds could prove to be better suited to the pediatric setting with arthritis.
幼年特发性关节炎（JIA）是一种儿童期风湿性疾病，疼痛是主要的早期症状，10-17%的患者疼痛仍然是主要症状。关于 JIA 患者膝关节的感觉阈值变化的数据非常有限，而炎症通常在膝关节表现出来。我们通过定量感觉测试（QST）来确定 JIA 是否与膝关节的感觉阈值变化有关，并建立儿童膝关节的参考值。
16 名 9-18 岁的 JIA 患者，一侧膝关节受累，患者自述视觉模拟评分（VAS）>10（0-100 分），以及 16 名健康对照者完成了研究并纳入分析。QST 是按照德国神经性疼痛研究网络（DFNS）标准进行评估的。疾病严重程度用青少年疾病活动评分（JADAS）来确定。感知疼痛用视觉模拟量表（0-100）来评估。QST 在 6-9 岁的患者中进行了可行性测试。
在 9 岁以下的儿童中，有 3 名 JIA 患者的 QST 测试结果不可行。9 岁及以上的 JIA 患者报告平均 VAS 疼痛评分为 54.3。与健康对照组相比，QST 发现压力疼痛阈值（PPT）显著降低，冷觉阈值（CDT）升高。PPT 在受累和未受累的膝关节均降低，CDT 在未受累的膝关节降低，而不在受累的膝关节降低。
在荷兰的 JIA 患者队列中，QST 仅在 9 岁及以上的儿童中可行。此外，膝关节的感觉阈值变化仅限于 JIA 患者的压力疼痛和冷觉检测阈值。
本文表明，在荷兰人群中，广泛的 QST 方案仅在 9 岁及以上的年龄组可行，而包含至少压力疼痛阈值和冷觉检测阈值的 QST 测试的简化集可能更适合关节炎儿童的儿科环境。
